Welcome to Al-Kindy College Medical Journal (KCMJ) KCMJ is a peer-reviewed open access publication ( three issues/year) of Al Kindy College of Medicine, University of Baghdad, Iraq. It founded in January 2004. Mission and vision The mission of the KCMJ is to provide a platform for high-quality medical knowledge exchange for Iraqi researchers and scientists from abroad. New findings and observations on issues related to preventive and clinical medicine are our targets. The aim of this journal is to contribute to scientific exchange, stimulate new research questions, find practical solutions, and adapt evidence-based professional action in the field of medical practice. The Journal prefers articles on studies that are well designed, supported by adequate and reliable data from all parts of the world. Focus and Scope The Journal publishes Original Articles, Editorials, Case Reports, Review Articles, and Letters to the Editor. Peer review KCMJ operates a double-blind review process. All submissions will be initially assessed by the Editorial Committee for suitability for the journal. Papers considered suitable are then typically sent to a minimum of two independent expert reviewers to assess the scientific quality of the paper. The double-blind review is the practice of this journal, which means the identities of the authors are concealed from the reviewers, and vice versa. More information is available on our website The Editorial Committee is responsible for the final decision regarding acceptance or rejection of articles. Availability The journal is published in digital and printed form. Full-text articles can be accessed for free via the internet. P- ISSN (print):1810-9543, E-ISSN (online): 2521-4365 No submission fee, an only publication fee of 100, 000 ID if the works are accepted. We waive the publication fee for authors from outside Iraq.
AL-Kindy College of Medicine - University of Baghdad
A Global Misuse of Semaglutide for Cosmetic Weight Loss in Non-diabetic Young Population, an FDA Public Database and Google Trends Data Analysis
Background: in a world full of aesthetic trends and a pervasive focus on physical appearance, often driven by celebrities and social media influencers. The misuse of medications and increased demand on aesthetic surgeries have been documented and become increasingly concerning. Recently, the use of GLP-1 analog medications for aesthetic weight management, particularly Semaglutide (brand name Ozempic and Wegovy) has gained increasing popularity among the public on these platforms. Subjects and Methods: Our study aimed to investigate the potential for Semaglutide misuse, particularly Ozempic based on FAERS database and Google Trends tool. We also explored the potential adverse events associated with Semaglutide medication's misuse. Results: Our findings showed a surge in Semaglutide medication (Ozempic) for weight loss as opposed to T2DM treatment worldwide. Moreover, Ozempic popularity for weight loss outweighs the popularity of Wegovy, which was approved for weight management indications in obese patients with at least one weight-related comorbidity. Furthermore, our results demonstrated an annual increase in the number of Semaglutide-related AERs on FAERS from January 2018 to September 2024, including a rise in death related AERs. A wide verity of Semaglutide related AERs have been documented, including both serious and non-serious outcomes, with death being the most serious outcome reported. Current results have also documented a worldwide shortage in Semaglutide medications, particularly Ozempic and Wegovy, due to increased demand and off-label use of these medications. Conclusion: collectively, our findings provide clear evidence of Ozempic and Wegovy misuse outside their approved indications to achieve aesthetic weight goals among young non-diabetic individuals. This misuse is often driven by media platforms without stressing on the potential adverse events and ethical concerns associated with the misuse of these medications.
Copyright (c) 2025 AL-Kindy College Medical Journal http://creativecommons.org/licenses/by/4.0
The Impact of Personalized Medicine on Enhancing Quality of Life in Chronic Diseases Management
Personalized Medicine represents a recent revolution in healthcare practice, focusing on tailoring different therapies to be precise for a specific individual; this is aided by exploring the number of genetic predispositions and lifestyle choices that fit each individual. In this article, the authors utilize and gather recent literature and opinions to discuss the impact of personalized medicine on chronic disease management and patient quality of life. Additional attention is paid to limits and possible ethical issues. Chronic diseases such as Hypertension, Diabetes, and chronic kidney diseases adversely affect multiple health indicators, including Quality of Life (QoL) and well-being. This will have additional impacts on physical and mental health that require further mitigations and to deal with more ongoing mental health. Personalized medicine is a revolutionary step that could be used to manage chronic disease by improving patients' QoL through tailored treatments. However, it is crucial to handle equity, ethics, and infrastructure issues.
Copyright (c) 2025 http://creativecommons.org/licenses/by/4.0
Hepatitis B virus infection in pregnant women in Baghdad
Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy.
Copyright (c) 2013 http://creativecommons.org/licenses/by/4.0
Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy. Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy. Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy. Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy.
A Cautionary Perspective on Artificial Intelligence and Novel Imaging Technologies in Patient Selection for Retrograde Intrarenal Surgery
The advancement of retrograde intrarenal surgery (RIRS) has been accompanied by the evolution of many promising tools that aim at improving patient selection and predicting surgery outcomes in terms of stone fragmentation and expected complications. The incorporation of artificial intelligence (AI) into the advanced imaging technologies such as dual-energy CT scan (DECT), three-dimensional (3D) reconstruction, and radiomics resulted in a number of clinical tools and algorithms forwarded to surgeons to use in their daily practice. This commentary critically examines these clinical algorithms, highlighting the absence of prospective validation, the potential for overreliance, and the possible limitations of their clinical applicability. AI-driven predictive models often rely on retrospective, uniform datasets taken from a single center, with evident interpretability concerns. Similarly, DECT and 3D reconstructions might provide detailed information about the anatomy of the renal collecting system and stone composition, but they do not account for real-time surgical dynamics. Radiomics, in the other hand, provides excellent insights into stone behavior, but their reproducibility and clinical relevance are still to be tested. The take-home message of this commentary is that conventional CT metrics—such as stone size and density—continue to outperform novel techniques in reliability and accessibility, and the adoption of emerging technologies in RIRS must be cautious, ethically sound, and evidence-based, reinforcing the primacy of clinical judgment in urologic care.
Applying the Principles of Sustainability to Diabetes Care in Low Resources Settings: Reduce, Reuse, Recycle
\ Background: Sustainability in healthcare is a relatively new concept that aims to integrate environmental, financial, and social factors. Diabetes care in low socioeconomic communities relies on disposable medical supplies, leading to increased waste. This study aims to propose the application of the (reduce, reuse and recycle) framework in diabetes care to enhance sustainability Subjects and Methods: This study used a mixed-methods approach, including both a literature review and a pilot survey. The literature review included fifty studies focusing on sustainable healthcare practices. A survey was conducted among fifty healthcare professionals and fifty patients to assess their baseline knowledge about practices related to sustainability in healthcare. Results were analyzed to assess similarities or differences between high and low socioeconomic communities Results: The survey revealed that 63% of patients thought treatment costs was the primary barrier to sustainability, while 50% of healthcare providers pointed to limited resources. Both groups emphasized the need for government support and education to enhance sustainability efforts. Reusable insulin pens and eco-friendly packaging were the most viable solutions. Conclusions: Applying sustainability to diabetes care can reduce both environmental and economic burdens. This is particularly challenging in low-resource settings, where cost and infrastructure limitations persist. Policy reforms, education, and innovation to reduce waste is essential to achieve a sustainable healthcare system.
Omega-3 Supplementation is Effective in Reducing Interleukin-6 Levels After Physical Exercise: A Systematic Review
Not only does physical exercise improve health, it can also trigger inflammation. Therefore, supplementation after exercise is necessary to reduce it. Omega 3 is one of the nutrients that can potentially reduce inflammation. The fundamental however, the mechanism is not well known. This study examined how omega-3 supplementation while exercise affected IL-6 levels, an inflammatory biomarker. Our systematic review analysis examined interleukin 6, inflammation, and omega 3 papers from Pubmed, Web of Science, and Science Direct during the previous five years. This systematic review assessed nine eligible papers. This research assessed standard operating procedures using PRISMA. Taking omega-3 supplements while working out has been shown to reduce IL-6 levels. IL-6 is reduced by omega-3 supplementation during exercise. So, this can be a recommendation for sportsmen in routine consumption to prevent inflammation during exercise.
A Bibliometric Analysis of Global Research on Dementia and its Cognitive Function
Introduction: Dementia is a neurocognitive disease manifested by progressive and global declination in cognition. However, there is a lack of visualization analysis on research in the field of dementia and cognitive function. To evaluate the impact and compare the scholarly work output and productivity among organizations, bibliometrics was used. Material and methods Literature related to dementia and cognitive function were searched from Scopus database. In the area of dementia bibliometrics was used to analyze the leading authors, the journals with higher citation, higher collaboration between the countries, and keywords. Scopus analysis and Biblioshiny R-package were used in the analysis of country collaboration and global cited documents. Results: Total 1753 articles were identified from Scopus database and among these 425 articles were included in the study on basis of inclusion criteria. United states, China and Japan has the highest productivity and China, USA, Australia, Canada and Indonesia and has strong collaboration. The research hotspots in this field focused on Dementia and its impact on cognitive function. According to Lotka’s Law the studies in the field of dementia is limited and need to be conducted further. Conclusion: Dementia is a major public health issues in India and this study has thrown light on all articles which has manifested the current trends and important areas of research on dementia. After an intensive analysis the study concluded that there is still a gap in international collaboration among leading countries. In India dementia can be a research gray area and focus of future attention.
Effect of Vitamin D3 on Colonization Genes Expression of Haemophilus influenzae Isolated from Children with Otitis Media Associated with Temporomandibular Joint Pain
Background: Acute otitis media (AOM) is the middle ear inflammation caused by various microorganisms, including bacteria. Haemophilus influenzae is a common bacterium that causes this inflammatory condition. This study aimed to determine the role of cholecalciferol (D3) in the expression of colonization genes in H. influenzae isolated from children with otitis media, which is associated with temporomandibular joint pain. Subjects and Methods: A total of 160 ear swabs and blood samples were collected from children with recurrent acute otitis media (AOM) for culture and sensitivity tests. The number of patients with pain in the TMJ was recorded, whether by pressure on the joint area or during mouth opening. Vitamin D3 was measured using an Enzyme-Linked Immunosorbent Assay. The minimum inhibitory and bactericidal concentrations of vitamin D3 were identified. Quantitative real-time PCR was used to evaluate the impact of this vitamin on the expression of pilA, hmw1, and hmw2. Results: This study showed that H. influenzae caused 28.12 % of AOM, and this inflammation occurred in 30.6% of children aged 1-2 years. Interestingly, 14.38 % of AOM patients had TMJ pain, while 85.62 % did not. Vitamin D3 levels in AOM patients were lower than those in normal children. The current study demonstrated that the expression of colonization genes in H. influenzae, the most common bacterium causing AOM, is upregulated in the absence of vitamin D3. However, these genes' expressions are downregulated in the presence of this vitamin. Conclusions: This study demonstrated that vitamin D3 inhibited the colonization gene expression of H. influenzae and altered the expression of these genes, suggesting therapeutic roles in infection prevention.
Al-Kindy College Medical Journal: An Audit of Publications for One Decade (2015-2024)
The Al-Kindy College Medical Journal (KCMJ) is an Iraqi scholarly journal published by the Al-Kindy College of Medicine, University of Baghdad. It was officially founded in 2004. It is a peer-reviewed journal, published in both online and printed forms. It has a mission to offer a publication platform that mirrors recent knowledge and findings in the field of medicine and medical sciences. It publishes various types of articles, including editorial, review article, research article, brief report, case report, and letter to editor. It accepts articles in the English language. It was biannually published till 2021 when it started to launch three issues per year. The journal is registered with numerous partners, including Iraqi Academic Scientific Journals (IASJ), CrossRef, Google Scholar, Researchgate, Scopus, Open Access Scholarly Publishing Association (OASPA), Committee on Publication Ethics (COPE), Directory of Open Access Journals (DOAJ), and Digital Object Identifier (DOI) System. The journal is archived by Clockss and Repository of the University of Baghdad. All articles published in the journal are freely available for everyone to read and access. Globally, a publication audit is usually exercised as it is regarded as an indispensable tool to evaluate the scientific progress of a particular academic journal in terms of achieving higher quality, attaining wider visibility, attracting more or better researchers/authors, getting recognition, expanding journal's dissemination, increasing the number of subscriptions, and planning for the future development.
Comparative Analysis of Short-Term Outcomes in Thoracoscopic Minimally Invasive Versus Traditional Mitral Valve Replacement: Randomized Clinical Trial Study
Background: The standard approach for mitral valve surgery was a sternotomy, but with the new trends, mitral valve surgery can now be performed with right mini thoracotomy incision. Minimally invasive mitral valve surgery has demonstrated superior cosmetic outcomes, less surgical trauma, shortened intensive care unit and hospital stays, cost effectiveness, and faster recovery, while the efficacy is comparable to conventional sternotomy. Objective: The aim of this research is to investigate the short-term outcomes of thoracoscopic minimally invasive mitral valve replacement in comparison with the conventional technique. Subjects and Methods: This study included 100 patients with isolated mitral valve disease, who were randomly divided into two equal groups. Group A underwent a right anterolateral video-assisted mini-thoracotomy, while Group B was approached via a conventional median sternotomy. Results: The minimally invasive group had significantly longer total operative time (291.3±48.89 min vs. 227.68±49.18 min, p = 0.001). However, Group A demonstrated better post-operative outcomes, including shorter ICU stay (2.1±1.07 vs. 3.82±1.49 days, p = 0.002), shorter extubation time (4.24±1.12 vs. 8.45±4.55 hours, p = 0.0001), reduced post-operative blood loss (271.7±107.09 ml vs. 449.2±230.93 ml, p < 0.0001). Post-operative pain scores were significantly lower in Group A (VAS 3.84±1.53 vs. 7.58±1.62, p < 0.0001), and hospital stay was shorter (7.22±1.37 vs. 11.21±3.53 days, p < 0.0001). Conclusions: Minimally invasive mitral valve surgery can be a safe and effective alternative to traditional MVS in patients with mitral valve disease.
Thoracoscopic Minimally Invasive Mitral Valve Surgery
Obesity-Induced Mechanisms in Colorectal Cancer Development: A Narrative Review
Obesity is a significant risk factor for colorectal cancer (CRC), influencing its development through multiple biological pathways. Elevated levels of insulin, insulin-like growth factor-1 (IGF-1), leptin, resistin, and inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) contribute to colonic cell proliferation and tumor formation. Additionally, obesity-induced hormonal imbalances, including decreased adiponectin and ghrelin, further increase CRC risk. Changes in gut microbiota due to obesity also play a role in carcinogenesis, highlighting the complex interplay between metabolic, inflammatory, and microbial factors. This review explores the pathophysiological mechanisms linking obesity to CRC, emphasizing its role as a modifiable risk factor. Insulin resistance, chronic inflammation, oxidative stress, and dysregulated adipokine secretion are key contributors to CRC progression in obese individuals. By analyzing molecular and epidemiological evidence, this review underscores the importance of early CRC screening for obese individuals, along with lifestyle modifications such as weight loss, dietary improvements, and increased physical activity. Furthermore, microbiome-targeted interventions, including probiotics and prebiotics, may help counteract obesity-driven dysbiosis and reduce CRC risk. Emerging biomarkers and therapeutic targets offer potential for developing obesity-specific CRC treatments. Given the rising global burden of CRC, integrating preventive healthcare strategies, public health initiatives, and clinical interventions is essential for reducing its incidence and improving patient outcomes. Addressing obesity through targeted preventive measures can significantly lower CRC-related morbidity and mortality, making it a crucial aspect of cancer prevention and management
An Epidemiological Review of the Impact of COVID-19 on Achilles Tendon Rupture Injuries, Experience from a Large London District General Hospital
Background: During the lockdown for COVID-19, hospitals experienced a reduction in the number of trauma admissions related to high energy, sport, and occupational injuries. As lockdown measures began to ease, hospitals experienced a high admission rate of patients presenting with Achilles Tendon Rupture [ATR]. However, in the post-pandemic phase, the number of cases reduced. The aim of this paper is to report changes in incidence and identify changes in demographics, mechanism of injury, and Achilles Tendon Rupture management pre- and post-pandemic. Subjects and Methods: We undertook a review during six different time periods of our Achilles Tendon Rupture patients, the time periods included: pre-pandemic, during the first after the first lockdown, during the second lockdown, after the second lockdown and the post-pandemic period. Patient’s demographics, mechanism of injury, past medical history, the use of steroids and patient management, Achilles tendon Total Rupture Score (ATRS) were all included. Results: One hundred and sixty-three patients were included in the study. During the second lockdown [1st January 2021- 11th April 2021], the average age of patients was significantly lower than any other group [p <0.005]. 40% of patients after the first lockdown [August 2020- December 2020] were treated surgically and this was significant [p-value <0.005], during all other time periods; the vast majority of patients were treated conservatively. For the entire cohort, 71.78% of patients were treated conservatively, whilst the other 28.22% were treated surgically. There was no statistical difference in the Achilles Tendon Rupture Score-based [p-value - 0.729] when comparing the management of Achilles Tendon Rupture, at least 8 months post-treatment. Conclusions: During each national lockdown, there was a decrease in the number of patients who presented with Achilles Tendon Rupture to hospital. Following the second lockdown, the number of patients who presented with ATR has significantly increased. However, in the post-pandemic phase, the number of cases decreased again. The study also found no significant difference in long-term outcomes as measured by the Achilles Tendon Rupture Score (ATRS), regardless of treatment approach. these findings suggest that the pandemic had a transient but marked impact on Achilles Tendon Rupture incidence, and further research is needed to explore the underlying mechanisms of this pattern, as well as the long-term outcomes and potential preventive strategies for Achilles Tendon Rupture in the post-pandemic era.
Assessment of VDR Gene Polymorphism (FokI) in Epithelial Ovarian Cancer Using PCR-RFLP Method
Background: Epithelial ovarian cancer (EOC) has been associated with genetic variations in the vitamin D receptor (VDR) gene among women in different geographical locations. Due to inadequate detection methods, many cases are diagnosed at advanced stages. Vitamin D deficiency and the FokI gene polymorphism in the VDR gene are known to increase cancer risk. The current study aimed to evaluate the correlation between the VDR gene polymorphism (FokI) and epithelial ovarian cancer risk Subjects and Methods: A prospective case-control study with 160 participants comprised 80 patients with epithelial ovarian cancer and 80 controls without the disease. FokI genotyping was observed using the PCR-RFLP technique, which allows for the precise identification of genetic variants in the VDR gene. Additionally, vitamin D levels were assessed through chemiluminescence immunoassay, providing quantitative data on vitamin D status. Results: Serum vitamin D levels showed no clear association with ovarian cancer risk across tertiles (p > 0.05). Genetic analysis identified significant genotype distributions in cases versus controls, with the CC genotype associated with reduced risk (OR = 0.5238, 95% CI: 0.042 - 0.5238) and the CT genotype with increased risk (OR = 1.9091, 95% CI: 0.047 - 1.9091) of ovarian cancer. Conclusions: Findings underscore the multifaceted nature of ovarian cancer etiology, suggesting that CT genotype in FOK1 gene increases the risk of ovarian cancer
A Comparative Study between Intravenous Lidocaine (0.5%) and Prilocaine (0.5%) in Intravenous Regional Anesthesia (Bier’s Block)
Background: Bier’s block is a reliable, straightforward, and safe technique for anesthetizing upper limb. This study aimed to compare between the effectivity of IV Lidocaine (0.5%) and IV Prilocaine (0.5%) in Bier’s block in terms of onset and recovery time of sensory and motor block, tourniquet tolerance, vital signs during and after surgery, and the need for intraoperative analgesia. Subjects and Methods: This study was conducted at Erbil Teaching Hospital and Emergency Hospital, from the period of May 2021 to October 2021. In this prospective, randomized, double-blind study, two groups of 25 patients were prepared for hand operation. Patients in group A were given IV Lidocaine (0.5%) while patients in group B were given IV Prilocaine (0.5%). Sensory and motor block and their recovery times, tourniquet pain, intra-operative analgesic needs, vital signs, and visual analog scale (VAS) scores were recorded. Results: No significant difference was found in the onset of sensory and motor block in both Lidocaine (5.5±1.6 min) and Prilocaine (5.9±1.6 min) groups (p-value=0.319), while the recovery of sensory block after releasing tourniquet was significantly shorter in Prilocaine group (7.4±1.4 min vs. 5.4±0.8 min) (p-value=0.003). The VAS score of Prilocaine group during and after surgery was significantly higher, with more patients receiving analgesia (5 vs. 2). Conclusions: Both IV Lidocaine (0.5%) and IV Prilocaine (0.5%) appeared to be effective local anesthetics in Bier’s block of distal upper extremity, intraoperatively and postoperatively. IV Lidocaine (0.5%) provided greater analgesia, while IV Prilocaine (0.5%) exhibited quicker sensory block recovery after tourniquet cuff release.
Immunohistochemical-Based Detection of Human Cytomegalovirus in Brain Tissues from a Group of Iraqi Patients with Glioblastoma Multiforme and WHO Grade II Astrocytoma
Background: Human Cytomegalovirus (HCMV) nucleic acids and proteins are frequently detected in brain tumors, especially high-grade gliomas in adults and children. Despite conflicting data, further investigation into HCMV's role in gliomas is warranted. Objective: This study aimed to determine the frequency of HCMV proteins in tissues from patients at the Specialized Surgeries Hospital in Baghdad diagnosed with glioblastoma multiforme (GBM) and grade 2 astrocytoma. Subjects and Methods: Ninety-three (93) tissue samples were collected from patients aged 8-75 years: 46 samples from GBM surgeries and 27 from astrocytoma surgeries. An additional 20 samples collected from non-tumor neurosurgical patients such as (Eosinophilic granuloma and reactive gliosis) aged 21-71 years were included as a control group. Immunohistochemistry (IHC) was used to detect immediate early and early HCMV proteins. Results: Of the 73 glioma tissues, 38 (52.1%) showed positive IHC signals for HCMV. In GBM tissues, 28 out of 46 (59.9%) were positive, while in astrocytoma tissues, 10 out of 27 (38.4%) were positive. Only 1 out of 20 control tissues (5%) showed HCMV positivity. Within the GBM group, low, moderate, and high IHC scores were observed in 57.1%, 28.6%, and 14.3% of cases, respectively. In the astrocytoma group, scores were low in 60%, moderate in 30%, and high in 10%. Significant statistical differences were noted when comparing GBM and astrocytoma to the control group and comparing GBM to astrocytoma Conclusions: The study revealed a high prevalence of HCMV in glioma samples, supporting its potential role in glioma development, particularly in GBM pathogenesis and possibly carcinogenesis.
A Revolutionary Road Map for Obesity Management and Beyond: Tirzepatide as a Dual-Acting Insulinotropic Polypeptide
Tirzepatide is a revolutionary and promising medication with a high impact in the treatment of Obesity and T2DM with their complications. Its efficacy was proven through different trials in achieving favorable weight loss and a significant reduction in glycemic index. It also treated a large diversity of related co-morbidities, including fatty liver, cardiovascular disease, dyslipidemia, and more. Tirzepatide is well tolerated, has a good safety profile, and is highly reliable and suitable for use in a population.
Copyright (c) 2024 AL-Kindy College Medical Journal http://creativecommons.org/licenses/by/4.0
Screening and Evaluation of Osteoporotic Biomarkers in Smoking Individuals in Basrah City, Iraq
Background: Prolonged cigarette smoking leads to significant bone loss, an independent risk factor for osteoporosis. Currently, there are no effective prevention procedures for this, and the exact mechanisms affecting bone metabolism remain unclear. Objectives: This study aims to (1) identify the differences in measured osteoporotic biomarkers among smokers, which are categorized based on the duration and smoking intensity, (2) identify a statistical correlation between variables and smoking intensity, (3) discuss the possibility of employing the appearance of pain sensations in healthy smokers as a reliable indicator of osteoporosis. Subjects and Methods: A study involved 200 males in Basrah city, aged 20-60 years, who were categorized into long-term heavy smokers (LTHS), long-term light smokers (LTLS), short-term current smokers (STCS), and non-smokers (control). A self-reported questionnaire was used to collect baseline data and smoking history. Serum levels of bone-specific alkaline phosphatase (BALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), interleukin 6 (IL-6), osteocalcin (OC), Dickkopf-1 (DKK-1), osteoprotegerin (OPG), and Receptor activator of nuclear factor kappa-B ligand (RANKL) biomarkers were measured using an ELISA technique. Results: statistical analysis for mean age 32± 8 years demonstrated a statistically significant relationship (P<0.05) in education levels, employment status, and type of diet among smoker groups. The prevalence of pain symptoms and pain severity showed (P<0.0001) among smoker groups compared to the control group. Among smokers, IL-6, vitamin D, BALP, OC, DKK-1, OPG, and PTH levels were statistically significant. The RANKL/OPG ratio shows significant differences in LTHS and LTLS. Conclusions: The Basra community's smoking status is influenced by education, employment state, and dietary profile. The high prevalence of smoking and its negative health effects significantly on osteoporotic biomarkers, and pain prevalence is positively correlated with smoking intensity.
Pregnant Mothers’ Knowledge, Attitude, and Practice Towards Prevention of Iron Deficiency Anemia in Georgia
Background: Anemia in pregnancy is a serious global health challenge, particularly affecting developing countries. Objectives: This study aimed to explore pregnant women's attitudes and perceptions regarding preventing iron deficiency anemia (IDA). Subjects and Methods: A qualitative research method was used to survey pregnant women with IDA and physicians through in-depth interviews. The target sample consisted of 9 gynecologists and 26 pregnant women, selected through purposive sampling from three maternity hospitals in Tbilisi (Georgia). Results: The majority of pregnant women (n=22; 84.6%) had some knowledge about IDA and correctly identified its symptoms. However, despite high awareness, most lacked adequate knowledge about the causes and risk factors of IDA. While pregnant women were aware of healthy eating practices, they did not follow a proper diet. Obstacles to healthy eating included limited financial access to food as well as cultural and religious barriers. Although respondents had some knowledge about iron-rich foods, they were generally unaware of the need to take iron supplements for prevention. The majority of pregnant women (n=21; 80.8%) received little information about anemia from their family physicians, indicating a limited role of family doctors in IDA prevention during pregnancy. Conclusions: Although pregnant women possess knowledge and positive attitudes towards IDA prevention, their practices remain insufficient. The findings suggest a weak connection between knowledge of IDA prevention and healthy behavior, contributing significantly to anemia prevalence. To address this issue, it is essential to promote proper nutritional counseling for pregnant women during antenatal care, with a focus on strengthening family doctors' involvement. Additionally, awareness should be increased among women of reproductive age and adolescent girls.
Regenerative Medicine with Recombinant Human Granulocyte Colony Stimulating Factor: Insights and Applications
Regenerative medicine is an interdisciplinary approach that introduces treatment modalities that mimic natural biological mechanisms. These treatment modalities include growth factors, cytokines modulation of the signaling cascade, and customized tissue engineering therapies with the least invasive methods. Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine that enhances granulocyte lineage cell proliferation, differentiation, and activation. Evidence-based studies have analyzed the effect of using recombinant human rh G-CSF on stem cell and progenitor cell recruitment and tissue repair and regeneration via anabolic protein upregulation and antiapoptotic mechanism enhancement. Promising regenerative effects of rh G-CSF administration have been reported in medical fields, such as providing long-term effects of neuroprotection in Parkinson's, Huntington's, and Alzheimer's diseases, ischemic disease, wound healing, diabetic foot repair, cardiovascular disease, reproductive biology, liver disease, and osteoid tissue regeneration.
The Role of Insulin-Like Growth Factor (IGF-1) Signaling During Physical Exercise: A Systematic Review
Exercise is one of the non-pharmacological therapies that functions to improve public health. This study seeks to determine how increased IGF-1 levels during exercise as a hormone can trigger growth. For this study, a number of journal databases were searched, such as PubMed, Web of Science, Embase, and Science Direct. This study considers several aspects, such as research on exercise and IGF-1 published in reputable journals over the past five years. Our analysis only includes items published in reputable international journals. Using databases total of 159 publications were found. In this comprehensive analysis, about ten carefully selected and peer-reviewed papers were included. The standard operating procedure for this investigation was developed using Preferred Reporting Systematics and Meta-analysis (PRISMA). Based on the results of this systemic investigation, exercise has been shown to increase IGF-1 levels, a hormone that promotes growth. Physical exercise as a therapeutic effort and a means of improving public health.
Fibroblast Growth Factor Receptor 3 Mutations in Bladder Cancer: A Marker for Early-Stage Diagnosis
Background: Bladder cancer (BC) ranks as the tenth most common cancer globally, with a high recurrence rate. It is primarily caused by abnormalities in the epithelial layer lining the bladder and is classified from non-muscle invasive bladder cancer (NMIBC) to muscle-invasive bladder cancer (MIBC). Fibroblast Growth Factor Receptor 3 (FGFR3) S249C mutation is frequently observed in low-grade NMIBC but are rare in high-grade NMIBC and MIBC, leading to continuous receptor activation and promoting tumor growth. Objective: This study aims to investigate the prevalence of FGFR3 S249C mutation in Iraqi BC patients, assess their association with tumor stage and grade, evaluate the potential of FGFR3 mutation as an early-stage diagnostic marker, and discuss implications for public health policy. Subjects and Methods: The study was conducted at Al-Safeer Hospital, Karbala, Iraq. It included 60 individuals diagnosed with urothelial BC (50 males, 83.3%; 10 females, 16.4%) with a median age of 63 years. Tumor tissue samples from patients undergoing Transurethral Resection of Bladder Tumor (TURBT) were used. DNA was extracted from formalin-fixed paraffin-embedded (FFPE) tumor tissue samples, and FGFR3 mutations were examined through direct DNA sequencing, focusing on the S249C mutation in exon 7. The prevalence of the S249C mutation was analyzed in relation to tumor stage and grade. Results: The study revealed a significant prevalence (55%) of the S249C mutation. This mutation was more frequent among males and individuals over the age of 50 years. There was a higher incidence of BC in males (83.3%) compared to females (16.7%), especially in those aged 50 years and older. Histomorphological evaluations showed a considerable number of tumors classified as low-grade. Furthermore, pathological staging results identified pT1 as the most common stage, followed by pTa and pT2, underscoring the predominance of early-stage tumors within the study population. Conclusions: This study highlighted the significant prevalence of FGFR3 S249C mutation in Iraqi BC patients. FGFR3 mutations were strongly associated with early-stage and low-grade tumors, indicating their potential as a molecular marker for early diagnosis.
Formalin Fixed Paraffin-Embedded Samples
Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare?
Background: Approximately 13-59% of myocardial infarction patients develop ischemic mitral regurgitation, impacting left ventricular function and increasing mortality risk. Optimal management of moderate ischemic mitral regurgitation remains controversial, raising the question of whether adding mitral valve surgery to coronary artery bypass graft (CABG) has an overall advantage over revascularization or not. Objective: To investigate the early and mid-term comparison between the two techniques. Subjects and Methods: This randomized clinical trial was conducted at Assuit University Heart Hospital, on 50 patients randomized into two groups: Group A: 25 patients underwent CABG and Group B: 25 patients had CABG and mitral valve repair. Inclusion criteria was multi-vessel coronary artery disease, moderate ischemic mitral regurge (MR). All patients were subjected to full history taking, routine physical, laboratory investigations and transthoracic echocardiography. Intraoperative data was collected. Early outcomes included MR degree, and left ventricular (LV) diameters and function, ICU stay duration, and in-hospital mortality. Mid-term outcomes included MR degree, LV diameter and function. Results: Groups had similar age and gender distribution. Repair procedures showed longer ischemic and operative times than CABG alone (P≤0.0001 and P=0.0012). Early post-operative, repair reduced MR significantly (P≤0.0001). At six months follow-up, CABG group had more rate of improvement than repair group (P≤0.0001). Conclusions: In moderate ischemic mitral regurgitation with multi-vessel ischemic heart disease, adding mitral valve repair to CABG may reduce mitral regurgitation severity early and at six months compared to CABG alone. However, CABG alone offers shorter ischemic times and operative durations.
Diagnostic Performance of Cytocolposcopy versus Biopsy for Premalignant and Malignant Lesions in a Women's Hospital Dysplasia Clinic
Background: Cervical cancer (CRC) is a public health problem because it is the fourth most common gynecologic neoplasm worldwide. The screening tests used to diagnose this pathology are cervical cytology, which in suspected malignancy or with malignancy requires colposcopy to identify the affected area and thus guide the biopsy, which is the gold standard for diagnosis. Therefore, these tests are complementary, and a high diagnostic concordance is required to make a confident diagnosis. Subjects and Methods: A retrospective, cross-sectional, observational, and analytical study was performed. A total of 1470 medical records were analyzed, of which 175 patients met the inclusion criteria. The cyto-colposcopic diagnostic yield was compared with the histopathologic yield. The concordance between screening tests and the gold standard was calculated using Cohen's kappa coefficient Results: The sample comprised 175 subjects who met the selection criteria (11.9%). The mean age was 34.59 + 11.01 years, ranging from 17 to 65 years. The mean sexual debut was 16.6 years, with a mean of 3.1 ± 2 sexual partners. When patients were classified according to lesion type, the highest percentages were found in low-grade squamous intraepithelial lesions (LSIL). With 45.71, 61.14, and 49.14% for cytologic, colposcopic, and histopathologic examination, respectively. The highest concordance between histopathology and cytology was found in the high-grade squamous intraepithelial lesion (HSIL) with 0.41, and the concordance between histopathology and colposcopy in HSIL and cancer was 0.55 and 0.74, respectively. Conclusions: Papanicolaou tests and colposcopy showed moderate concordance with histopathologic findings; the diagnostic accuracy of colposcopy is superior to that of cytology.
Effectiveness and Safety of Highly Purified Human Menopausal Gonadotropin in Hyper Responder Iraqi Females Undergoing Intracytoplasmic Sperm Injection
Background: The response to ovarian stimulation in females is heterogeneous, so treatment individualization offers both safety and efficacy. The use of highly purified human menopausal gonadotrophin (HP-hMG) during controlled ovarian stimulation is widely accepted nowadays but with absence of evidence demonstrating the advantages of this gonadotrophin. Objective: To evaluate the efficacy and safety of highly purified human menopausal gonadotrophin vs. recombinant follicle-stimulating hormone (rFSH) in controlled ovarian hyperstimulation for hyper responder females undergoing intracytoplasmic sperm injection. Subjects and methods: Eighty- one sub-fertile females who were admitted to the infertility center of High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Al- Nahrain university, during the period from January 2020 to December 2023 were included in the present study. GnRH antagonist down regulation was used for all participants. According to gonadotrophin type used for ovarian hyperstimulation females were divided into 2 groups: group who was stimulated with r- FSH and the other group who were stimulated with HP-hMG. Results: Females who were stimulated by r-FSH showed insignificantly higher total number of retrieved oocytes, mature oocytes and lower immature oocytes yield. In addition, they had a significantly higher pregnancy rate (29 % vs 0%), and higher OHSS rate (26.08% vs 16.66%), compared to those stimulated by HP-hMG. Conclusion: In hyper responders; highly purified human menopausal gonadotrophin provides lower efficacy but higher safety than recombinant follicle-stimulating hormone in terms of oocyte yield, pregnancy rate and OHSS development
recombinant follicle-stimulating hormone
highly purified human menopausal gonadotrophin
Deciphering Neuro-Ophthalmic Presentations of Carotid Cavernous Fistulas: A Comprehensive Analysis of Venous Flow Dynamics and Clinical Implications
Background: Carotid cavernous fistulas (CCFs) are abnormal arteriovenous connections between the carotid arterial system and the cavernous sinus, presenting with complex neuro-ophthalmic manifestations due to the redirection of arterial blood into the venous system. This study systematically reviews the diverse neuro-ophthalmic presentations of CCFs, emphasizing the influence of venous flow dynamics. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science, focusing on keywords such as "carotid cavernous fistula," "neuro-ophthalmic presentations," and "optic nerve compression." Recent and historical studies were analyzed to assess the neuro-anatomical impacts on neuro-ophthalmic symptoms from CCFs. This review aimed to consolidate knowledge and refine diagnostic and therapeutic strategies for CCF management. Results: The findings demonstrated that the neuro-ophthalmic presentations were quite distinctive, depending on the direction of venous flow. Anterior flow, overall, was associated with proptosis, conjunctival arterialization, and red, dilated vessels. In contrast, posterior flow was associated with cranial nerve complications, most notably abducens nerve palsy and trigeminal neuralgia, manifesting as double vision and facial pain, respectively. It therefore seems that the symptomatology and severity of CCFs is heavily dependent on the direction of blood flow. Conclusion: The flow direction through the veins is of significant importance in the clinical presentation and prognosis of CCFs. These dynamics must be appreciated to improve diagnosis and allow for optimal treatment, thus averting the risk of fatal complications. In this review, the need for tailored therapeutic strategies through detailed vascular and neuro-ophthalmologic analysis is outlined.
Addressing Psychoactive Drug Use in Iraq: Embracing Challenges and Seizing Opportunities
Drug use disorder is a global health issue and one of the leading causes of premature deaths and disability. There is an increase recognition of the need for a public health rather than criminal justice approach to mitigate the current health burden and prevent future health loss
Active Human T- lymphotropic Virus Type-1 Antigenemia in a Sample of Iraqi Patients on Maintenance Hemodialysis
Background: Human T-lymphotropic virus type-1 (HTLV-1) is an oncogenic retrovirus that causes lifelong and asymptomatic infection, with a high incidence globally. Patients undergoing hemodialysis are more likely to acquire blood-borne viral infections, including HTLV-1. Therefore, they are considered one of the highest-risk groups for the acquisition of this virus. Objectives: This study aims to identify the HTLV-1 antigenemia among hemodialysis patients, and to investigate the potential risk factors and co-viral infections with Hepatitis B and C viruses. Subjects and Methods: This cross-sectional study involved 130 hemodialysis patients attending the dialysis center at Imamein Kadhimein Medical City in Baghdad, Iraq in the period between November 2023 and January 2024. Using enzyme-linked immunosorbent assay was applied for the detection of HTLV-1 specific capsid antigen (p24) in the serum of the studied group. The data was analyzed using specific statistical methods. Results: Out of 130 participants, 60(46.2%) actively contracted HTLV-1 infection, comprising 37 (28.5%) males and 23 (17.7%) females. The detection of HTLV-1antigen was significantly correlated with the patient’s age (0.0037), but not with marital status, frequency of blood transfusion, and hemodialysis duration. Moreover, active HTLV-1 infection was related to co-infections with HCV 18(13.9%) and HBV 5(3.8%) of patients. Conclusions: In this study, hemodialysis patients were predominantly affected by HTLV-1 infection. Therefore, it is of utmost importance to implement screening protocols to curb the transmission of this infection within hemodialysis units. Further research involving a significant cohort encompassing diverse regions of Iraq is recommended to ascertain the accurate prevalence of HTLV-1 infection.
Artificial Intelligence-Based Prediction of Intra-Aortic Balloon Pump Need in High-Risk CABG Surgery: Enhancing Clinical Decision Support
Background: In modern healthcare, decision-making processes are becoming increasingly data-driven, aiming to optimize patient care and resource allocation. Coronary artery bypass grafting (CABG) is a critical procedure for high-risk patients, and the use of intra-aortic balloon pump (IABP) assistance can significantly impact patient outcomes. Objective: To identify preoperative factors that predict the need for IABP assistance in high-risk CABG patients and to develop a predictive model that can enhance clinical decision-making. Subjects and Methods: The study involved fifty high-risk coronary artery bypass graft patients, with 24 cases necessitating intra-aortic balloon pump assistance and the rest not requiring it. Seven preoperative variables, including age, weight, ejection fraction, number of grafts, creatinine level, diabetic status, and blood pressure, were considered as potential predictors. SPSS was adopted to conduct a multi-variable regression analysis and derive the mathematical equations for the predictive model. A graphical user interface (GUI) was developed to utilize these equations for predicting the need for IABP support. Results: The findings revealed a strong correlation among several preoperative factors and the likelihood of requiring IABP assistance. By employing the predictions from the model to guide preoperative intra-aortic balloon insertion, the potential for optimizing hemodynamic support during surgery was maximized. Conclusions: This research emphasizes the importance of enhancing risk assessment techniques to empower medical specialists to tailor treatment plans to each patient's specific needs. Early identification of individuals at risk of requiring IABP can significantly enhance surgical outcomes and patient safety. Incorporating the predictive model into clinical practice allows for more individualized and effective care during high-risk CABG surgeries. This modern strategy has the potential to revolutionize cardiac outcomes, improve patient results, and extend the use of intra-aortic balloon support.
Role of microRNA-499-5p in Early Diagnosis of Acute Coronary Syndrome and its Subtypes Compared with Highly Sensitive Cardiac Troponin –I
Background: Acute coronary syndrome (ACS) is still one of the main causes of morbidity and mortality worldwide, to decrease mortality rates if diagnosed early. The ACS classification into three subtypes depends on electrocardiogram. miRNA-499-5p was found to be substantially elevated in AMI patients as compared with the non-AMI group and healthy control and it was already detectable in the plasma 1h after the onset of chest pain in AMI patients Objectives: To evaluate the role of measuring serum miRNA-499-5p value in early diagnosis of ACS and compare with hscT-I Subjects and Methods: A total of 120 patients (72 males and 48 females) aged≥30 years were consecutively selected from those who were admitted and diagnosed with ACS. The healthy subjects as controls for this study were recruited from those who had no current illness. The serum miRNA-499-5P and hscT-I were measured. Results: It was shown that miRNA-499-5p levels had an overall significant difference among study groups (p<0.001), also the miRNA-499-5p mean level was significantly different between each ACS subgroup and controls (P<0.001) miRNA-499-5p showed a significant positive correlation with hscT-I 0hrs in STEMI and NSTEMI but UA showed a non-significant correlation. miRNA-499-5p level had perfect AUC and high sensitivity and specificity for discrimination between subgroups of ACS patients. Conclusions: The present study found the values of serum miRNA-499-5p expression in patients with ACS patients are significantly higher compared with controls after 1h of onset of chest pain, additionally, miRNA-499-5p expression have high sensitivity and specificity for differentiation between subgroups of ACS and from controls.